Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions

A pilot trial of metformin for insulin resistance and mood disturbances in adolescent and adult women with polycystic ovary syndrome

We examine the effects of metformin on insulin resistance (IR) and mood including in adolescent and adult women with polycystic ovary syndrome (PCOS). This trial was conducted in 19 adolescents (age ≤18 years) and 25 adult (age >18 years) women with PCOS. Anthropometric and measurements including, serum glucose, endocrine panel, and lipid profile were performed at baseline. IR was measured by Homeostasis Model Assessment IR (HOMA-IR). Anxiety and depression were measured by Beck's Anxiety (BAI) and Depression Inventories (BDI-II). All tests were repeated after a 90-day treatment with metformin (1,500 mg/day). The severity of depression and anxiety decreased after 90-day treatment with metformin in women diagnosed with PCOS. The BAI scores were higher in adolescent group while BDI-II scores were higher in the adult group (p = .016). After 90-day metformin treatment, both BDI-II and BAI scores were decreased by 3.3 and 3.4, respectively (p < .001). Indicators of IR and obesity were improved with this therapy. Although the adolescents weighed lower than the adults, baseline HOMA-IR 5.5 ± 1.7 was higher in this group than 4.4 ± 1.2 in the adult women (p =.022). The findings suggest that metformin decrease IR and improve mood both in adolescent and adult women with PCOS.

Resolvin D1 impacts on insulin resistance in women with polycystic ovary syndrome and healthy women

AIMS

The aim of this study was to determine the association between the intake of omega-3 PUFAs and the serum level of resolvin D1 and insulin resistance in women with Polycystic Ovary Syndrome (PCOS) compared to healthy women.

METHODS

A cross-sectional study was conducted in 2015-2016 in Tehran, Iran, among females referred to the infertility clinic at Valie-Asr Reproductive Health Research Centre. Thirty-one patients with PCOS (according to the criteria of the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM)) and 29 healthy, normal cycling (NC) women of similar age, weight and height were enrolled. Anthropometric measurements, levels of resolvin D1, fasting insulin, glucose levels and insulin resistance index (HOMA) for each of the patients were determined.

RESULTS

Intakes of macronutrients (protein, carbohydrates, and total fat) and omega-3 PUFAs were higher in the PCOS group compared to the control group; also, the PCOS group had significantly higher resolvin D1, fasting insulin, glucose levels and HOMA when compared with the control group. Moreover, resolvin D1 correlated negatively with HOMA and fasting insulin levels among both the PCOS and control women.

CONCLUSION

PCOS is associated with insulin resistance. We showed that omega-3 PUFAs can increase the synthesis of resolvin D1. Resolvin D1 is involved in insulin sensitivity by affecting insulin signaling and inflammatory pathways. Therefore, it can be a contributing factor in reducing insulin resistance in PCOS patients.

Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis

PURPOSE

Polycystic ovary syndrome (PCOS) is a common disorder affecting up to 15% of women in the reproductive age. Prior studies suggest that PCOS can be associated with mood and psychiatric disorders. The purpose of this study is to examine the prevalence of any psychiatric disorder in women with PCOS.

METHODS

We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through February 08, 2017 for studies that examined the prevalence of any psychiatric disorder in adolescents or adults with a clinical or biochemical diagnosis of PCOS. We used a random-effects model to generate pooled estimates and 95% confidence intervals (CI).

RESULTS

We included 57 studies reporting on 172,040 patients. The majority of studies addressed depression and anxiety. Studies had fair methodological quality although most estimates were unadjusted. Women with PCOS were more likely to have a clinical diagnosis of depression (odds ratio (OR), 2.79; 95% CI, 2.23-3.50), anxiety (OR, 2.75; 95% CI, 2.10-3.60), bipolar disorder (OR, 1.78; 95% CI, 1.43-2.23) and obsessive compulsive disorder (OCD) (OR, 1.37; 95% CI 1.22-1.55), but not social phobia or panic disorder. Using various scales, the severity of symptoms of depression, anxiety, obsessive compulsive disorder, and somatization disorders were higher compared to women without PCOS.

CONCLUSIONS

PCOS is associated with an increased risk of diagnosis of depression, anxiety, bipolar disorder, and obsessive compulsive disorder. It is associated with worse symptoms of depression, anxiety, OCD, and somatization. Screening for these disorders to allow early intervention may be warranted.

The influences of vitamin D and omega-3 co-supplementation on clinical, metabolic and genetic parameters in women with polycystic ovary syndrome

OBJECTIVE

The aim of this study was to evaluate the effect of the co-administration of vitamin D and omega-3 fatty acid on clinical, metabolic and genetic parameters in women with polycystic ovary syndrome (PCOS).

METHODS

This randomized, double-blinded, placebo-controlled clinical trial was conducted on 60 subjects, aged 18-40 years old with PCOS. Subjects were randomly allocated to take either 50,000 IU vitamin D every 2 weeks plus 2000 mg/day omega-3 fatty acid from fish oil (n = 30) or placebo (n = 30) for 12 weeks. Gene expression analysis of inflammatory cytokines was conducted on peripheral blood mononuclear cells (PBMCs) of PCOS women using RT-PCR method.

RESULTS

Vitamin D and omega -3 fatty acid co-supplementation significantly decreased serum total testosterone levels (-0.2 ± 0.5 vs. + 0.1 ± 0.4 ng/mL, P = 0.02) compared with the placebo. In addition, vitamin D and omega-3 fatty acid co-supplementation resulted in a significant improvement in beck depression inventory (-1.4 ± 1.6 vs. -0.5 ± 0.6, P = 0.01), general health questionnaire scores (-4.5 ± 4.3 vs. -1.9 ± 2.3, P = 0.005) and depression anxiety and stress scale scores (-5.0 ± 5.1 vs. -2.3 ± 3.5, P = 0.01) compared with the placebo. Additionally, vitamin D and omega-3 fatty acid co-administration significantly decreased serum high-sensitivity C-reactive protein (hs-CRP) (-1.2 ± 1.9 vs. + 0.1 ± 0.7 mg/L, P = 0.001) and malondialdehyde (MDA) levels (-0.4 ± 0.4 vs. + 0.2 ± 0.6 µmol/L, P < 0.001), and significantly increased plasma total antioxidant capacity (TAC) levels (+ 114.6 ± 122.2 vs. -2.4 ± 168.2 mmol/L, P = 0.003) compared with the placebo. Results of RT-PCR demonstrated that vitamin D and omega-3 fatty acid co-supplementation significantly downregulated gene expression of interleukin-1 (IL-1) (P = 0.03), and upregulated vascular endothelial growth factor (VEGF) (P = 0.004) in PBMCs of subjects with PCOS, when compared with placebo.

CONCLUSIONS

Overall, the co-administration of vitamin D and omega-3 fatty acid for 12 weeks had beneficial effects on mental health parameters, serum total testosterone, hs-CRP, plasma TAC and MDA levels, and gene expression of IL-1 and VEGF among women with PCOS.

Potential genetic polymorphisms predicting polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a heterogenous endocrine disorder with typical symptoms of oligomenorrhoea, hyperandrogenism, hirsutism, obesity, insulin resistance and increased risk of type 2 diabetes mellitus. Extensive evidence indicates that PCOS is a genetic disease and numerous biochemical pathways have been linked with its pathogenesis. A number of genes from these pathways have been investigated, which include those involved with steroid hormone biosynthesis and metabolism, action of gonadotropin and gonadal hormones, folliculogenesis, obesity and energy regulation, insulin secretion and action and many others. In this review, we summarize the historical and recent findings in genetic polymorphisms of PCOS from the relevant publications and outline some genetic polymorphisms that are potentially associated with the risk of PCOS. This information could uncover candidate genes associating with PCOS, which will be valuable for the development of novel diagnostic and treatment platforms for PCOS patients.

A Cross-sectional Study on the Proportion of Anxiety and Depression and Determinants of Quality of Life in Polycystic Ovarian Disease

BACKGROUND

The polycystic ovary syndrome is a disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphologic features. Earlier studies have shown that depression was significantly increased in the polycystic ovarian disease (PCOD) group and also that PCOD women had marked reduction in quality of life, impaired emotional well-being, and reduced sexual satisfaction. This study was undertaken with the objectives of studying the proportion of anxiety and depression and assessing the quality of life and its correlates in women with PCOD.

MATERIALS AND METHODS

A cross-sectional observational study on 64 PCOD patients using a pro forma for collecting sociodemographic and clinical details, Hamilton Depression Rating Scale, Hamilton Rating Scale for Anxiety, Ferriman-Gallewey score for hirsutism and WHO-quality of life (QOL) BREF.

RESULTS

Depression was seen in 93.5% of the subjects and anxiety in 100% of the subjects. The patients were also seen to have a lower quality of life. Lower scores were obtained in the psychological domain (68.80 ± 12.87). Presence and severity of depression and anxiety were found to have a negative correlation with QOL in all domains but maximally affecting the social relationships domain (P ≤ 0.001 and <0.001, respectively). Severity of hirsutism and nulliparity was found to have association with QOL in the psychological domain.

CONCLUSION

The majority of women with PCOD in this study were found to have depression and anxiety. They were also seen to have a lower quality of life. Depression, anxiety, and hirsutism were found to have a negative correlation with QOL in all domains.

Polycystic Ovarian Syndrome-Related Depression in Adolescent Girls: A Review

Polycystic ovarian syndrome (PCOS), a common endocrinal disorder of reproductive age characterized by heterogeneous complications, is nowadays prevailing among females at adolescent stage. Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity can occur in women with PCOS. In adolescents, infrequent or absence of menstruation may raise chances for this condition. The increased prevalence of PCOS among general population throughout the world is found to be 5%-10% in the women of reproductive age, and about 40% women with PCOS experience depression, particularly young girls. The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications. Depression and anxiety are common in women with PCOS but are often overlooked and therefore left untreated. Along with the physical disturbances, many mental problems are also associated with PCOS. Therefore, PCOS not only has problems associated with reproduction but also has associated crucial metabolic and psychological health risks with increasing age of the patients. Because of the increased number of cases with PCOS around the world in present times, with prominent symptom of, specifically, depression at the adolescent stage, it is important to highlight the disease.

Effects of synbiotic supplementation on metabolic parameters and apelin in women with polycystic ovary syndrome: a randomised double-blind placebo-controlled trial

Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women of reproductive age. Insulin resistance is a main pathophysiologic feature in these patients. According to some studies, the intake of probiotic bacteria may improve glucose homoeostasis. The aim of this study was to investigate the effect of synbiotics on metabolic parameters and apelin in PCOS patients. This randomised double-blind placebo-controlled trial was conducted on eighty-eight PCOS women aged 19–37 years old. The participants were randomly assigned to two groups receiving (1) synbiotic supplement (n44), and (2) placebo (n44) for 12 weeks. Fasting blood samples were taken at baseline and after 12 weeks. The two groups showed no difference in fasting blood sugar (adjusted mean difference: 0·60; 95 % CI −3·80, 5·00,P=0·727), plasma glucose fasting 2-h (adjusted mean difference 2·09; 95 % CI −9·96, 14·15,P=0·134), HbA1c (adjusted mean difference 0·06; 95 % CI −0·09, 0·22,P=0·959), homoeostatic model assessment-insulin resistance (HOMA-IR) (adjusted mean difference: 0·02; 95 % CI −0·99, 1·03,P=0·837), quantitative insulin sensitivity check index (QUICKI) (adjusted mean difference: −0·02; 95 % CI −0·33, 0·29,P=0·940) and C-reactive protein (CRP) (adjusted mean difference: 0·24; 95 % CI −1·61, 2·08,P=0·141) by the end of the intervention. A significant difference was observed in the mean apelin 36 before and after the intervention between synbiotic and placebo groups (adjusted mean difference: −4·05; 95 % CI −7·15, −0·96,P=0·004). A 12-week synbiotic supplementation has no significant beneficial effects on HOMA-IR and CRP in PCOS patients, whereas the level of apelin 36 significantly decreased.

Association of the Pro12Ala Polymorphism with the Metabolic Parameters in Women with Polycystic Ovary Syndrome

AIM:

To investigate the association of peroxisome proliferator-activated receptor gamma (PPARG) Pro12Ala polymorphism with polycystic ovary syndrome (PCOS) and its effect on the metabolic parameters in PCOS women.

METHODS:

The study used PCR to identify the presence of the PPARG Pro12Ala polymorphism in 100 PCOS women and 120 age-matched healthy women. All participants were subjected to anthropometry, biochemical and metabolic evaluation.

RESULTS:

Significant difference in the genotypes distributions of PPARG Pro12Ala polymorphism was observed among PCOS women and controls (p = 0.03). The frequency of the polymorphic allele Ala was significantly higher in PCOS cases than that in the controls (OR = 2.01, p = 0.01). The carries of the variant allele Ala in PCOS women showed significant higher values in body mass index (BMI), systolic and diastolic blood pressure, waist circumference, waist to hip ratio, sum of skin folds, fasting blood glucose, fasting blood insulin, HOMA-IR, fasting triglycerides, total cholesterol and low-density lipoprotein than non-carriers.

CONCLUSION:

The PPARG Pro12Ala polymorphism might contribute to the risk of PCOS and abnormal metabolic parameters and could be considered as a biomarker for early diagnosis and clinic prediction of metabolic complications.

Hyperhomocysteinemia Promotes Insulin Resistance and Adipose Tissue Inflammation in PCOS Mice Through Modulating M2 Macrophage Polarization via Estrogen Suppression

It has been shown that serum homocysteine (Hcy) levels are higher in women with polycystic ovary syndrome (PCOS). However, the specific role of hyperhomocysteinemia (HHcy) in the development of PCOS has never been reported. Adipose tissue inflammation is featured by the infiltration of macrophages, which plays a critical role in the pathogenesis of glucose and insulin intolerance. In this study, C57BL/6 mice were treated with dehydroepiandrosterone (DHEA) and/or a high methionine diet to induce PCOS and HHcy mice models. We showed that DHEA induced a PCOS-like phenotypes, irregular estrous cycles, weight gain, abnormal sex hormone production, glucose and insulin resistance, and polycystic ovaries. HHcy further intensified the effects DHEA on the metabolic, endocrinal, hormonal, and morphological changes in PCOS-like mice. In addition, HHcy attenuated the DHEA-induced increase in serum estrogen levels in mice. Furthermore, HHcy may exacerbate the insulin resistance in PCOS-like mice, most likely through modulating the macrophage M1/M2 polarization pathways via the suppression of estrogen. Most important, our clinical data showed that there were increases in serum Hcy levels in patients with PCOS. These findings deepen our understanding of the pathological roles of HHcy in the development of PCOS and provide a promising target for PCOS therapy in clinical application.

Acupuncture treatment for insulin sensitivity of women with polycystic ovary syndrome and insulin resistance: a study protocol for a randomized controlled trial

BACKGROUND

Our prospective pilot study of acupuncture affecting insulin sensitivity on polycystic ovary syndrome (PCOS) combined with insulin resistance (IR) showed that acupuncture had a significant effect on improving the insulin sensitivity of PCOS. But there is still no randomized controlled trial to determine the effect of acupuncture on the insulin sensitivity in women with PCOS and IR. In this article, we present the protocol of a randomized controlled trial to compare the effect of true acupuncture on the insulin sensitivity of these patients compared with metformin and sham acupuncture. Acupuncture may be an effective therapeutic alternative that is superior to metformin and sham acupuncture in improving the insulin sensitivity of PCOS combined with IR.

METHODS

This study is a multi-center, controlled, double-blind, and randomized clinical trial aiming to evaluate the effect of acupuncture on the insulin sensitivity in PCOS combined with IR. In total 342 patients diagnosed with PCOS and IR will be enrolled. Participants will be randomized to one of the three groups: (1) true acupuncture + metformin placebo; (2) sham acupuncture + metformin, and (3) sham acupuncture + metformin placebo. Participants and assessors will be blinded. The acupuncture intervention will be given 3 days per week for a total of 48 treatment sessions during 4 months. Metformin (0.5 g per pill) or placebo will be given, three times per day, and for 4 months. Primary outcome measures are changes in homeostasis model assessment of insulin resistance (HOMA-IR) and improvement rate of HOMA-IR by oral glucose tolerance test (OGTT) and insulin releasing test (Ins). Secondary outcome measures are homeostasis model assessment-β (HOMA-β), area under the curve for glucose and insulin, frequency of regular menstrual cycles and ovulation, body composition, metabolic profile, hormonal profile, questionnaires, side effect profile, and expectation and credibility of treatment. Outcome measures are collected at baseline, at the end of treatments, and 3 months after the last acupuncture treatment. On completion of the screening visit, randomization will be conducted using a central randomization system.

DISCUSSION

This study will investigate the effects of acupuncture on the insulin sensitivity of PCOS and IR women compared with metformin and sham acupuncture. We will test whether true acupuncture with needles placed in skeletal muscles and stimulated manually and by electrical stimulation is more effective than metformin and sham acupuncture with superficial needle placement with no manual or electrical stimulation in improving the insulin sensitivity in PCOS women with IR.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02491333 ; Chinese Clinical Trial Registry, ChiCTR-ICR-15006639. Registered on 24 June 2015.

The predictors of quality of life in women with polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorder that may be effective in reducing the quality of life. This study aimed to determine the predictors of quality of life in women with PCOS. This cross-sectional study was conducted on 174 women with PCOS who attended in public and private fertility clinics in Urmia (West Azerbaijan, Iran), 2015. The data were collected through the questionnaires of sociodemographic and obstetrics characteristics, quality of life and Beck depression inventory-II. Multivariate linear regression was used to estimate the effect rate of the independent variables (depression and sociodemographic characteristics) on the dependent variable (quality of life). In this study, the mean (standard deviation) of total score of the quality of life was obtained, 45.8 (11.3) in the range 0-100. The highest and lowest mean scores were in the subdomains of weight and hirsutism. The variables of depression, body mass index, woman's job, menstrual cycle intervals, and sexual satisfaction were predictors of the quality of life in women with PCOS. Because of various effective factors on quality of life in these women such as depression, necessary strategies must be implemented to control these factors and improve the quality of life.

The role of stress in PCOS

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting a remarkable proportion of premenopausal women. Different studies have shown that stress is widely encountered in women with PCOS. Areas covered: As PCOS is a multifaceted disorder, 'stress' incorporates different translations. We performed a literature review, focusing on the most recent data, regarding the multipotent role of stress in the syndrome. Expert commentary: Stress is believed to be an important component of PCOS. It encompasses different definitions that are all equivalent, like metabolic, inflammatory, oxidative and emotional stress. However, the type of stress that distinguishes PCOS is metabolic stress. It becomes evident early in life and constitutes the pathophysiological heart of the syndrome. Metabolic stress along with the other types of stress are the progenitors of severe long-term health implications, which exacerbate further the reproductive, metabolic and psychological derangements of the syndrome, leading to an endless cycle of chronic illness.

The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance

BACKGROUND

Here we describe the consensus guideline methodology, summarise the evidence-based recommendations we provided to the World Health Organisation (WHO) for their consideration in the development of global guidance and present a narrative review on the management of anovulatory infertility in women with polycystic ovary syndrome (PCOS).

OBJECTIVE AND RATIONALE

The aim of this paper was to present an evidence base for the management of anovulatory PCOS.

SEARCH METHODS

The evidence to support providing recommendations involved a collaborative process for: (i) identification of priority questions and critical outcomes, (ii) retrieval of up-to-date evidence and exiting guidelines, (iii) assessment and synthesis of the evidence and (iv) the formulation of draft recommendations to be used for reaching consensus with a wide range of global stakeholders. For each draft recommendation, the methodologist evaluated the quality of the supporting evidence that was then graded as very low, low, moderate or high for consideration during consensus.

OUTCOMES

Evidence was synthesized and we made recommendations across the definition of PCOS including hyperandrogenism, menstrual cycle regulation and ovarian assessment. Metabolic features and the impact of ethnicity were covered. Management includes lifestyle changes, bariatric surgery, pharmacotherapy (including clomiphene citrate (CC), aromatase inhibitors, metformin and gonadotropins), as well as laparoscopic surgery. In-vitro fertilization (IVF) was considered as were the risks of ovulation induction and of pregnancy in PCOS. Approximately 80% of women who suffer from anovulatory infertility have PCOS. Lifestyle intervention is recommended first in women who are obese largely on the basis of general health benefits. Bariatric surgery can be considered where the body mass index (BMI) is ≥35 kg/m2 and lifestyle therapy has failed. Carefully conducted and monitored pharmacological ovulation induction can achieve good cumulative pregnancy rates and multiple pregnancy rates can be minimized with adherence to recommended protocols. CC should be first-line pharmacotherapy for ovulation induction and letrozole can also be used as first-line therapy. Metformin alone has limited benefits in improving live birth rates. Gonadotropins and laparoscopic surgery can be used as second-line treatment. There is no clear evidence for efficacy of acupuncture or herbal mixtures in women with PCOS. For women with PCOS who fail lifestyle and ovulation induction therapy or have additional infertility factors, IVF can be used with the safer gonadotropin releasing hormone (GnRH) antagonist protocol. If a GnRH-agonist protocol is used, metformin as an adjunct may reduce the risk of ovarian hyperstimulation syndrome. Patients should be informed of the potential side effects of ovulation induction agents and of IVF on the foetus, and of the risks of multiple pregnancy. Increased risks for the mother during pregnancy and for the child, including the exacerbating impact of obesity on adverse outcomes, should also be discussed.

WIDER IMPLICATIONS

This guidance generation and evidence-synthesis analysis has been conducted in a manner to be considered for global applicability for the safe administration of ovulation induction for anovulatory women with PCOS.

Study on the proportion and determinants of polycystic ovarian syndrome among health sciences students in South India

Introduction:

Polycystic ovarian syndrome (PCOS) constitutes most cases of endocrine disorder among females.

Objectives:

This study was done to assess the proportion of university students with PCOS and to study its risk factors.

Materials and Methods:

Data were collected from students of a private medical, dental, and nursing college using a self-administered questionnaire. Height and weight of all participants were recorded by standard procedures.

Results:

The mean age of students was 20.4 ΁ 1.5 years. Of the 480 participants, 39 (8.1%) were already diagnosed with PCOS. Out of the remaining 441 participants, 40 (9.1%) were at high risk, and 401 (90.9%) were at low risk for PCOS. Greater proportion of PCOS cases was seen in the age group 23-25 years (P = 0.026), among those with family history of PCOS (P = 0.002), among those who were permanent residents of urban areas (P = 0.048), and among those who were overweight or obese (P = 0.004). About 90% of PCOS cases and those at high risk for PCOS, each had difficulty in controlling excess weight or were experiencing difficulty in maintaining ideal weight. About 36 (92.3%) of PCOS cases and all those at high risk had emotional problems such as feeling moody or experiencing fatigability over the previous 2 weeks.

Conclusion:

PCOS is a common disorder among young women in this settings and this warrants periodic screening activities. A multidisciplinary approach is required to bring about lifestyle modification and help those with emotional problems due to this endocrine disorder.

Psychological aspects of hyperandrogenic states in late adolescent and young women

OBJECTIVE

The psychosocial implications of polycystic ovary syndrome (PCOS) phenotypes have been investigated in different patient populations, but little attention was paid to adolescent and young women. The aim of this study was to evaluate the psychosocial correlates of PCOS and other hyperandrogenic states in a population of late adolescent and young females and to provide a psychological characterization of specific clinical hyperandrogenic phenotypes.

DESIGN

This was a cross-sectional study.

PATIENTS

High school female students, aged 16-19 years.

MEASUREMENTS

The study protocol was designed with three possible levels of participation characterized by an increased level of commitment. For the specific purposes of this investigation, we focused on the subsamples of students whose clinical state was assessed by medical examination (n = 835) and for whom additional laboratory tests were available (n = 394). Psychological evaluation encompassed psychological distress, levels of stress, well-being, illness behaviour and quality of life (as measured by the Symptom Questionnaire, the Psychosocial Index and the Psychological Well-Being scales).

RESULTS

Significantly higher levels of psychological distress and impaired well-being and quality of life were found among late adolescent and young women with isolated clinical hyperandrogenism compared to their normal counterparts. Furthermore, females with PCOS showed significantly greater hostility/irritability compared to healthy control subjects.

CONCLUSIONS

These findings highlight the importance of early recognizing and adequately managing psychological distress in such patients.

Putative role for insulin resistance in depression risk in polycystic ovary syndrome

OBJECTIVE

To evaluate whether insulin resistance is associated with depression risk in women with polycystic ovary syndrome (PCOS), independent of other factors, including body mass index (BMI).

DESIGN

Cross-sectional.

SETTING

Tertiary university center.

PATIENT(S)

A total of 301 women, aged 14-52 years, with PCOS by Rotterdam criteria, consecutively examined between 2006 and 2013.

INTERVENTION(S)

Complete history and physical examinations, including endovaginal ultrasounds, dermatologic assessments, completion of Beck Depression Inventory Fast Screen (BDI-FS), and serum testing.

MAIN OUTCOME MEASURE(S)

Scores >4 on BDI-FS indicated a positive screen for depression. Scores were further subdivided into mild (5-8), moderate (9-12), and severe (>12) depression risk. Insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR).

RESULT(S)

A total of 131 women (44%) were at risk for depression, determined by positive BDI-FS screening. These patients had higher BMI (32.3 vs. 28.5), and elevated insulin resistance, assessed by HOMA-IR (5.2 vs. 2.6), compared with patients with negative depression screening. In a stratified analysis by BMI category, obese women with positive depression screens had elevated HOMA-IR, compared with obese women with normal BDI-FS scores (7.4 vs. 4.1). In a multivariate logistic regression analysis, HOMA-IR was independently related to the odds of depression risk after controlling for age, ethnicity, BMI, and exercise (odds ratio: 1.07).

CONCLUSION(S)

Depression is common in PCOS. After controlling for confounders in multivariate regression analyses, we found HOMA-IR to be significantly associated with depression risk. Our data suggest a complex interplay among insulin resistance, obesity, and depression in PCOS, warranting additional investigation. Mental health assessment is indicated in comprehensive care of patients with PCOS.

Mood disorders and quality of life in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) affects 5-10% of the population of women. The exact etiology of PCOS remains unclear, but it is believed to result from complex interactions between genetic, behavioral and environmental factors. The spectrum of its symptoms such as hirsutism, skin problems, obesity and finally infertility has a huge negative impact on the individuals' psychological and interpersonal functioning. PCOS symptoms can lead to significant deterioration in quality of life and be highly stressful negatively affecting psychological well-being and sexuality. Fear symptoms like palpitation, being out of breath and tension might be caused by many somatic diseases. Moreover, detection and continuous thinking about illness can lead to significant negative impact on individual functioning in society. PCOS may be a factor potentially favoring the occurrence of mood disorders and depression. Biological, social and psychological consequences of PCOS among women of reproductive age are opening a new perspective on management of women's health in these patients.

Estrogen receptor αlpha gene (ESR1) PvuII and XbaI polymorphisms are associated to metabolic and proinflammatory factors in polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that involves multiple factors. Although the etiology of PCOS is unknown, there is an involvement of sex steroid hormones in the pathophysiology of this syndrome. Therefore, polymorphisms in genes involved in the action of estrogen may contribute to a woman's susceptibility to PCOS.

AIM

This study aimed to evaluate the association between the polymorphisms PvuII and XbaI in the estrogen receptor alpha (ESR1) gene and the occurrence of PCOS. The study also aimed to assess the influence of these polymorphisms on the metabolic and inflammatory profiles of women with PCOS.

MATERIAL AND METHODS

This case-control study included 99 women with PCOS, diagnosed according to the Rotterdam criteria, and 104 age-matched healthy women. The polymorphisms were evaluated using polymerase chain reaction-restriction fragment length polymorphism.

RESULTS

No association between the ESR1 gene polymorphisms and the presence of PCOS was observed. However, we found associations between the PvuII polymorphism and C-reactive protein levels, testosterone levels, family history of diabetes, and waist circumference. The XbaI polymorphism was associated with fasting glucose and a family history of hypertension.

CONCLUSION

These polymorphisms are not associated with PCOS development, but they are involved in the phenotype of complications of the syndrome. Therefore, prior knowledge of these genomic variants might contribute to taking preventive measures that could delay the metabolic and reproductive complications commonly seen in women with PCOS.

Association of sympathovagal imbalance with cardiovascular risks in patients with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is associated with cardiovascular risks like obesity, insulin resistance, dyslipidemia that can lead to sympathovagal imbalance (SVI). The study was designed to assess the cardiovascular risk in PCOS and link of metabolic derangements to SVI. Thirty-five newly diagnosed PCOS patients and 32 age-matched controls were recruited. Waist-hip ratio, body mass index (BMI), basal cardiovascular parameters such as basal heart rate (BHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and rate pressure product (RPP) were recorded. Autonomic functions were assessed using short-term heart rate variability (HRV) analysis, heart rate and blood pressure response to standing (30:15 ratio), deep breathing (E:I ratio) and isometric handgrip (ΔDBPihg). Fasting plasma glucose, insulin, lipid profile and testosterone were assayed. Insulin resistance (HOMA-IR) and lipid risk factors were calculated. The cases had increased BHR, BMI, SBP, DBP, MAP and RPP. The ratio of low-frequency to high-frequency (LF-HF) of HRV, the marker of SVI was significantly increased in cases. 30:15 ratio and ΔDBPihg were increased and E:I ratio was decreased in the cases. HOMA-IR, lipid risk factors and testosterone were significantly elevated in cases. There was a significant correlation of LF-HF with BMI, BHR, RPP, insulin resistance and lipid risk factors. On regression analysis, insulin resistance and lipid risk factors had independent association with LF-HF. PCOS patients have SVI, decreased HRV and increased RPP and the potential cardiovascular risks. The insulin resistance and dyslipidemia contribute to SVI and cardiovascular risks in PCOS patients.

The relationship between clinicobiochemical markers and depression in women with polycystic ovary syndrome

BACKGROUND

Previous studies have demonstrated that clinical features of Polycystic ovary syndrome (PCOS) are associated with a lower degree of health, self, and sex satisfaction.

OBJECTIVE

Our study aimed to investigate possible associations between depression and different clinicobiochemical markers of PCOS.

MATERIALS AND METHODS

In a cross-sectional analytic study, 120 PCOS women aged 18-45 yr, were enrolled. Beck Depression Inventory was used to assess depression. Also, all participants underwent biochemical studies. Individuals with 15 points and more in Beck test were referred to a psychiatrist to participate in a complementary interview for the diagnosis of depression based on Diagnostic and Statistical Manual of Mental Disorders IV (DSMIV-TR) criteria.

RESULTS

Among the study participants, 82 women (68.3%) were non-depressed, and 38 patients (31.7%) had some degrees of depression. According to the psychiatric interview, 10 patients (8.3%) had major depression, 22 patients (18.3%) had minor depression and 6 patients (5%) had dysthymia. We failed to show any significant difference in body mass index, hirsutism, infertility, serum total testosterone, lipid profile, and the homeostasis model assessment of insulin resistance (HOMA-IR) between depressed and non-depressed subjects (p>0.05). Using Spearman correlation, we did not find a positive correlation between BDI scores and clinicobiochemical markers for all PCOS subjects (-0.139≤r≤+0.121, p>0.05).

CONCLUSION

In spite of high rate of depression in women with PCOS, there was no significant association between Clinicobiochemical Markers and depression.

Effects of resveratrol on ovarian response to controlled ovarian hyperstimulation in ob/ob mice

OBJECTIVE

To evaluate antidiabetic and anti-inflammatory effects of resveratrol on the ovarian response to controlled ovarian hyperstimulation (COH) in obesity-related infertility.

DESIGN

Experimental.

SETTING

University laboratory.

ANIMAL(S)

Sixteen female ob/ob mice and 16 female C57BL/6J mice undergoing COH.

INTERVENTION(S)

Wild-type placebo group; wild-type resveratrol group; ob/ob mice placebo group; ob/ob mice resveratrol group. Resveratrol 3.75 mg/kg daily for 20 days and undergoing COH protocol.

MAIN OUTCOME MEASURE(S)

Body and reproductive system weight, food intake, fasting blood glucose, plasma insulin and T levels, and Homeostatic Index of Insulin Resistance; interleukin-6 and tumor necrosis factor-α levels in adipose tissue by Western blot; assessment of quality and quantity of oocytes retrieved; and quantitative analysis of ovarian follicles.

RESULT(S)

Plasma insulin and T levels decreased and Homeostatic Index of Insulin Resistance improved in ob/ob mice treated with resveratrol. Interleukin-6 and tumor necrosis factor-α levels were significantly reverted back to near normalcy after resveratrol treatment in obese mice. Administration of resveratrol resulted in a significantly higher number of oocytes collected in wild-type mice. The number of primary, growing, preovulatory, and atretic follicles was found to be decreased in the group of obese mice treated with resveratrol when compared with the obese control group.

CONCLUSION(S)

Resveratrol administration could exert benefits against loss of ovarian follicles, and these actions may be mediated, at least in part, via anti-inflammatory, insulin-sensitizing, and antihyperandrogenism effects. These observations further validate the therapeutic potential of resveratrol to preserve ovarian reserve in conditions associated with obesity. Our results suggest the possible clinical use of resveratrol to enhance the ovarian response to COH in normal-weight females.

A neuropsychiatric complication of oligomenorrhea according to iranian traditional medicine

Oligomenorrhea, a prevalent disease with serious complications, has been declared in the Avicenna traditional medicine in detail. Avicenna in his famous book, Cannon of Medicine, presents a syndrome termed 'uterine strangulation', as a complication of menstrual bleeding cessation and lack of sexual satisfaction. We have explained this syndrome from both traditional and conventional medicine viewpoints to propose a new hypothesis for diagnosis and treatment of women with oligomenorrhea and systemic signs/symptoms admitting to clinics for further evaluation. This hypothesis definitely needs to be further assessed and confirmed by strong clinical trials.

Metastin levels in relation with hormonal and metabolic profile in patients with polycystic ovary syndrome

OBJECTIVE

The aim of the present study was to evaluate serum concentrations of metastin in relation with hormonal and metabolic profile in patients with and without polycystic ovary syndrome (PCOS).

STUDY DESIGN

The study was a clinical study. Eighty-three women with PCOS and 66 body mass index (BMI) matched controls were divided into two groups, based on BMI: overweight and obese (BMI≥25 kg/m(2)) and normal weight. (BMI<25 kg/m(2)) Hirsutism scores, hormonal and metabolic profile as well as metastin levels were evaluated in each subject. Blood samples were collected in the early follicular phase (between day 2 and day 5 of the menstrual cycle) at 9:00 AM, after an overnight fast. Circulating levels of LH, FSH, PRL, TSH, T, fT, DHEAS, 17-OH-P, sex hormone-binding globulin (SHBG), insulin, glucose, lipid profile and metastin were measured.

RESULTS

Metastin levels were significantly higher in the PCOS group compared to controls (2.02 ng/ml versus 1.16 ng/ml, p<0.001). Metastin levels correlated significantly positively with luteinizing hormone (LH), total testosterone (T), dehydroepiandrosteronesulphate (DHEA-SO4) levels, modified Ferriman-Gallwey (mFG) scores and free androgen index (FAI); however, correlated negatively with sex hormone binding globulin (SHBG) levels (p<0.05). When overweight or obese (BMI≥25 kg/m(2)) and normal weight (BMI<25 kg/m(2)) women with PCOS were compared to body mass index (BMI) matched controls, higher metastin levels were also found in PCOS groups (1.94 ng/ml versus 1.18 ng/ml, and 2.06 ng/ml versus 1.08 ng/ml, p<0.05, respectively).

CONCLUSIONS

These findings suggest that metastin levels were higher in women with PCOS as compared to controls regardless of BMI. Furthermore, metastin levels can be used as a specific marker for androgenic profile and this marker might play a role in the pathogenesis of PCOS.

Metabolic syndrome and polycystic ovary syndrome: an intriguing overlapping

Metabolic syndrome is an increasing pathology in adults and in children, due to a parallel rise of obesity. Sedentary lifestyle, food habits, cultural influences and also a genetic predisposition can cause dyslipidemia, hypertension, abdominal obesity and insulin resistance which are the two main features of metabolic syndrome. Polycystic ovary syndrome (PCOS) is a condition directly associated with obesity, insulin resistance (HOMA index) and metabolic syndrome, and it is very interesting for its relationship and overlap with the metabolic syndrome. The relationship between the two syndromes is mutual: PCOS women have a higher prevalence of metabolic syndrome and also women with metabolic syndrome commonly present the reproductive/endocrine trait of PCOS. Prevention and treatment of metabolic syndrome and PCOS are similar for various aspects. It is necessary to treat excess adiposity and insulin resistance, with the overall goals of preventing cardiovascular disease and type 2 diabetes and improving reproductive failure in young women with PCOS. First of all, lifestyle changes, then pharmacological therapy, bariatric surgery and laparoscopic ovarian surgery represent the pillars for PCOS treatment.

Interleukin-6 levels in relation with hormonal and metabolic profile in patients with polycystic ovary syndrome

OBJECTIVE

The aim of this study was to evaluate serum concentrations of interleukin-6 (IL-6) in relation with hormonal and metabolic profile in patients with and without polycystic ovary syndrome (PCOS).

METHODS

A total of 40 women with PCOS and 40 age-matched controls were eligible for the study. Hirsutism scores, hormonal and metabolic profile as well as IL-6 levels were evaluated in each subject.

RESULTS

Women with PCOS exhibited higher body mass index (BMI) and serum concentrations of IL-6 levels than controls (p < 0.05); however, levels of IL-6 were not significantly increased when compared with BMI-matched controls (p > 0.05). IL-6 levels were significantly correlated positively with BMI and triglyceride levels; however, negatively correlated with high-density lipoprotein levels.

CONCLUSION

The data of this study suggested that serum IL-6 levels were found to be higher in women with PCOS as compared to controls; however, IL-6 levels might be dependent on nutritional status but not on PCOS per se. Raised serum IL-6 levels may be related to BMI and serum lipid levels and may be a predictor for cardiometabolic risks.

Apelin levels in relation with hormonal and metabolic profile in patients with polycystic ovary syndrome

OBJECTIVE

To evaluate serum concentrations of apelin in relation to the hormonal and metabolic profile in patients with and without polycystic ovary syndrome (PCOS).

STUDY DESIGN

A total of 45 women with PCOS and 45 age-matched controls were eligible for the study. Hirsutism scores, hormonal and metabolic profile as well as apelin levels were evaluated in each subject.

RESULTS

Women with PCOS exhibited lower serum concentrations of apelin than controls (194.1±50.7pg/ml versus 292.1±85.6pg/ml, p<0.001). Apelin levels were significantly correlated positively with body mass index (BMI), insulin, triglyceride (TG), free testosterone (fT) levels, modified Ferriman Gallwey scores and Homeostasis Model Assessment (HOMA) index; but negatively correlated with high density lipoprotein (HDL) levels in patients with PCOS (p<0.05). When overweight or obese (BMI≥25) and normal weight (BMI<25) women with PCOS were compared to BMI-matched controls, lower apelin levels were found in the PCOS group (226.7±45.4pg/ml versus 378.6±80.9pg/ml and 165.5±36.1 versus 249.0±46.6pg/ml, p<0.001, respectively).

CONCLUSION

The data suggest that serum apelin levels are lower in women with PCOS than in controls. Furthermore, apelin can be used as a specific marker for insulin sensitivity and lipid profile and this adipokine might play a role in the pathogenesis of PCOS.

A life course perspective on polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a major public health problem in the US. Worldwide, the public is largely unaware of the condition and health care providers do not seem to fully understand it. Research on PCOS has primarily focused on its etiology and clinical characteristics and less on the psychosocial aspects of human development associated with PCOS. This paper posits that a life course perspective provides a framework for further understanding the psychosocial experiences of women with PCOS and the contexts in which they live. The paper discusses how life course principles of human development, constraints on agency, interdependence of lives, time and place, and timing of events and experiences are relevant to the management of PCOS and prevention of its complications.

Lifestyle intervention and anti-obesity therapies in the polycystic ovary syndrome: impact on metabolism and fertility

Obesity is frequently present in patients with polycystic ovary syndrome (PCOS) and plays an important role in the pathogenesis of the metabolic, endocrine, and reproductive abnormalities associated with this syndrome. We aimed to summarize the effects of lifestyle changes and anti-obesity pharmacotherapy in patients with PCOS. We reviewed the literature regarding the effects of lifestyle changes and anti-obesity agents on the metabolic and endocrine abnormalities of PCOS. Lifestyle changes, including diet, exercise, and behavioral modification, appear to improve the metabolic and reproductive abnormalities of overweight and obese patients with PCOS. Therefore, lifestyle changes appear to represent the first-line management for all overweight and obese patients with PCOS. However, the optimal composition of diet and the optimal type of exercise in these patients are unknown. Anti-obesity agents that have been studied in PCOS include orlistat, sibutramine, and rimonabant. However, the latter two agents have been withdrawn from the market because of side effects. Long-term studies with orlistat in overweight and obese diabetic patients showed greater weight loss and metabolic and cardiovascular benefits than those achieved with lifestyle changes alone. However, there are limited data on the efficacy of orlistat in women with PCOS. In conclusion, lifestyle changes (diet, exercise and behavioral modification), particularly when combined with anti-obesity agents, exert beneficial effects on the endocrine abnormalities of obese patients with PCOS and improve metabolic parameters.

Anxiety, cognitive, and depressive assessment in adolescents with polycystic ovarian syndrome: a pilot study

STUDY OBJECTIVE

Polycystic ovarian syndrome (PCOS) is a major endocrine disorder afflicting women of reproductive age group. Women with PCOS suffer from depressive and anxiety disorders and they are more likely to be depressed compared to healthy women. However, no studies have assayed the perception of the clinical manifestations of PCOS in the adolescent group. In this study, we aimed at analyzing the anxiety, cognitive, and depressive states of adolescent girls with PCOS.

DESIGN

A total of 37 adolescents presenting to a tertiary care center in Lebanon and aged 14-18 years participated in the current study. Socio-economic and demographic data were collected and self-reported questionnaires (FSIQ, SDQ, SCARED, and BDI) were presented to the study group and analyzed.

RESULTS

The FSIQ levels among adolescents with PCOS were significantly lower compared to healthy controls. Surprisingly, there were no differences between the adolescent girls with PCOS and the healthy age-matched girls in the anxiety and depressive states and in psychiatric symptoms.

CONCLUSIONS

This is the first study to assay for cognitive, anxiety, and depressive states in adolescent girls. No major differences were found among both groups except in cognitive levels. However, long-term follow-up for proper management of psychiatric disorders is warranted. Moreover, the latency of androgens and its contribution to psychiatric illnesses in women with PCOS could be a major factor for development of psychiatric symptoms, rather than the hyperandrogenic levels per se.

Assessment of cardiovascular autonomic function in patients with polycystic ovary syndrome

AIM

The study was conducted to assess the sympathovagal balance in patients with polycystic ovary syndrome (PCOS) using short-term heart rate variability (HRV) analysis and conventional autonomic function tests (CAFT).

METHODS

Thirty-one newly diagnosed patients with PCOS and 30 age-matched controls were recruited. Body mass index (BMI), waist : hip ratio (WHR), cardiovascular parameters such as basal heart rate (BHR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and rate-pressure product (RPP), and fasting blood glucose (FBG) were measured in both groups. Cardiovascular autonomic functions assessed were spectral analysis of HRV, heart rate and blood pressure response to standing (30:15 ratio), deep breathing (E:I ratio) and isometric handgrip (ΔDBP(ihg)).

RESULTS

The cases had significantly increased BMI, WHR, BHR, SBP, DBP and RPP. Ratio of low-frequency to high-frequency power of HRV (LF-HF ratio), the marker of sympathovagal balance was significantly increased in cases compared to controls. Time-domain indices of HRV and E:I ratio were decreased, and 30:15 ratio, ΔDBP(ihg) and FBG were increased in cases. Though there was a significant correlation of LF-HF ratio with BMI, WHR, BHR, RPP and FBG, only BHR and RPP had independent contribution to LF-HF ratio.

CONCLUSION

We conclude that PCOS patients have altered autonomic modulation in the form of increased sympathetic and decreased parasympathetic reactivity and HRV. The sympathovagal imbalance exposes them to cardiovascular morbidities.

Axis I and Axis II diagnoses in women with PCOS

OBJECTIVE

The objective was to determine the current prevalence of Axis I and Axis II psychiatric diagnoses in patients with polycystic ovary syndrome (PCOS).

METHOD

The study sample included 73 patients with PCOS and 73 control subjects. Psychiatric disorders were determined by structured clinical interviews.

RESULTS

The rate of any Axis I psychiatric disorder (28.8% vs. 15.1%), social phobia (13.7% vs. 2.7%), generalized anxiety disorder (11.0% vs. 1.4%), any Axis II psychiatric disorder (23.3% vs. 9.6%) and avoidant personality disorder (12.3% vs. 1.4%) was significantly more common in the patient group compared to the control group. Of women with PCOS, 21 (28.8%) had at least one Axis I and 17 (23.3%) had at least one Axis II diagnosis. The most common Axis I disorder was social phobia (13.7%) and the most common Axis II disorder was avoidant personality disorder (12.3%) in women with PCOS. Social phobia, generalized anxiety disorder, and avoidant personality disorder were significantly more common in the patient group compared to the control group.

CONCLUSION

Our results suggest that a considerable proportion of women with PCOS also present with anxiety and personality disorders.

Psychological investigation in patients with polycystic ovary syndrome

Background

The aim of the present study was to estimate the prevalence of mood disorders and examine a range of predictors for psychological well-being among Iranian women with polycystic ovary syndrome (PCOS).

Methods

A cross-sectional study was undertaken to ascertain the factors related to psychological distress in PCOS patients in Kashan, Iran. Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS). In addition we assessed quality of life using the Short Form Health Survey (SF-36). Socio-demographic details and clinical information of PCOS including obesity (body mass index), excessive body hair (hirsutism score), acne, menstrual cycle disturbances, infertility and endocrine profile also were recorded for each patient.

Results

In all 300 women with PCOS were entered into the study. Of these 32% (n =96) showed elevated HADS anxiety while depression was high in 5% (n =15). Quality of life was significantly impaired in women with anxiety (P <0.05), and depression (P <0.001) and in particular, in women with coexistence anxiety and depression (P <0.001) compared with unaffected participants. Compared with the non-depressed PCOS patients, the depressed women had significantly higher menstrual irregularities (P = 0.008). Moreover, we found significant difference in FAI level between the depressed and non depressed (p = 0.05), the anxious and non anxious patients (p < 0.001) compare to non affected PCOS women.

Conclusions

The high prevalence of depression and anxiety in this population suggests that initial evaluation of all women with PCOS should also include assessment of mental health disorders. The clinician should further pay attention to background of their patients especially in view of the factors influencing psychological well-being.

Polycystic ovary syndrome and depression in New Zealand adolescents

OBJECTIVE

To determine whether adolescents with polycystic ovary syndrome (PCOS) are more depressed than adolescent girls in the community and to examine factors associated with depression.

DESIGN

An observational study comparing clinical and community samples.

SETTING

Two specialist reproductive endocrine clinics in Auckland, New Zealand.

PARTICIPANTS

102 girls aged 14-19 presenting for clinical assessment, fulfilling the Rotterdam consensus for PCOS. The comparison group was 1349 girls from a school-based survey of New Zealand youth.

INTERVENTIONS

Clinically significant depression was identified by the long and short form Reynolds Adolescent Depression Scale. BMI, androgen levels, oral contraceptive use, objective symptom severity, age, ethnicity, and socioeconomic grouping were recorded.

MAIN OUTCOME MEASURES

Clinically significant depression in the PCOS and community samples. Potential determinants of depression.

RESULTS

Clinically significant depression in adolescent girls with PCOS was not increased compared with the community sample (OR 1.3; 95%CI 0.7-2.7, P = .42). Within the PCOS cohort, depression was correlated with increased BMI (P = .01) and possibly acne (P = .08).

CONCLUSIONS

Lean adolescent girls with PCOS did not have more clinically significant depression than girls in the community. Within the PCOS cohort, however, there was a clear association between higher depression scores and elevated BMI. There is a potentially important interaction between obesity and depression in PCOS.

Body weight reduction and metformin: Roles in polycystic ovary syndrome

BACKGROUND AND OBJECTIVES

Polycystic ovary syndrome (PCOS) is a common problem in women at fertile age. A prospective study was conducted to clarify the pathophysiological responses during an application of insulin sensitizer, metformin and weight reduction therapy at the Gynecology Center in Ohud hospital, in AL-Madinah AL-Munawarah, Kingdom of Saudi Arabia.

METHODOLOGY

Twenty healthy women served as controls and 180 PCOS women divided into three groups participated in the study. First group was treated with Clomid citrate 100mg/day from the 2nd day of menses to the 6th day plus gonadotrophin from day three to the 13th. Group II was treated as group I plus 850mg metformin twice a day and group III was treated as group I plus weight reduction. Clinical symptoms, menstrual pattern, hirsutism, blood glucose, body mass index, waist-to-hip ratio, insulin, hormonal, and lipid profiles were assessed pre- and post treatment. Insulin resistance was calculated.

RESULTS

PCOS women had significantly higher values than the healthy women in most of the measurements. Metformin and weight reduction therapy resulted in a significant decrease in the fasting insulin, glucose/insulin ratio and HOMA-IR. Metformin and weight reduction therapy resulted in a significant decrease in the lipid parameters, testosterone, LH/FSH ratio, SHBG, and prolactin levels. HOMA-IR was significantly higher in women with PCOS. HOMA-IR was positively correlated with testosterone, estradiol, TG, total cholesterol and LDL-cholesterol parameters, and negatively correlated with HDL-cholesterol and FSH levels.

CONCLUSION

Metformin therapy and weight reduction had favorable influences on the basic metabolic and hormonal profiles in women with PCOS and that metformin and lifestyle modification (weight reduction via diet restriction or exercise) resulted in a significantly greater weight loss than hormonal therapy alone. Metformin and weight reduction therapy decreased also hyperandrogenism and insulin resistance.

Factors contributing to initial weight loss among adolescents with polycystic ovary syndrome

STUDY OBJECTIVE

To evaluate the impact of a multidisciplinary clinic on weight management among adolescents with PCOS.

DESIGN

140 adolescent females were evaluated in a multidisciplinary PCOS clinic from March 2005 to December 2008. The team included a pediatric endocrinologist, health psychologist, dietitian, and pediatric gynecologist. 110 were diagnosed with PCOS based on the Rotterdam Criteria. Height, weight, BMI, number of subspecialists seen, use of metformin, and compliance with return visits were obtained from medical records.

SETTING

American Family Children's Hospital in Madison, Wisconsin.

PARTICIPANTS

110 adolescent females with polycystic ovary syndrome.

INTERVENTIONS

Consultation with a dietitian and health psychologist.

MAIN OUTCOME MEASURE

Change in weight.

RESULTS

The average age at first visit was 15.9 years. The average BMI was 34.7 kg/m(2) (range 18.1-55.5). Seventy-six percent had an initial BMI above the 95(th) percentile. Interactions with providers at the initial visit included a pediatric endocrinologist (100%), health psychologist (60.9%), dietitian (75.5%) and gynecologist (70.9%). Seventy one percent returned for a follow-up visit, (average time of 4.5 months between visits) with 57% achieving weight loss (average 3.5 kg) and an additional 12.6% demonstrating no significant weight gain (< 1.5 kg). Thus, 69.6% demonstrated weight loss/stabilization.

CONCLUSIONS

In this multidisciplinary clinic for adolescents with PCOS, nearly 70% of patients succeeded in short-term weight stabilization, with 57% demonstrating weight loss. Interactions with the health psychologist and dietitian appeared to play a key role in successful weight control, supporting the importance of psychology and nutrition expertise in the management of this disorder.

Genetic polymorphisms associated with steroids metabolism and insulin action in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is an endocrinopathy associated with infertility, diabetes and cardiovascular events. This study aimed to correlate polymorphisms of genes involved in the biosynthesis and metabolism of steroids and insulin action (CYP17A1, CYP19A1, AR, ESR1, ESR2, INSR, IGF2 and PAI1) with clinical and biochemical parameters of PCOS. DNA was extracted from peripheral blood samples obtained from 117 PCOS and 105 healthy women. The PAI1 insertion/deletion (-675 ins/delG) polymorphism (rs1799768) was genotyped by PCR-SSCP. CYP19A1 [TTTA](n), AR [CAG](n), ESR1 [TA](n), and ESR2 [CA](n) genes were evaluated by PCR-based GeneScan analysis, while CYP17A1 5'UTR (rs743572), INSR 1058 CT (rs1799817), and IGF2 3'UTR GA (rs680) polymorphisms were evaluated by PCR-RFLP. The results showed a prevalence of PAI1 4G5G+4G4G genotypes in PCOS (p = 0.025). Younger PCOS women showed a predominance of CT+TT, GA+AA and 4G5G+4G4G genotypes of INSR, IGF2, and PAI1 (p = 0.0499, p = 0.0300, p = 0.0350, respectively). AR shorter alleles (≤ 20 repeats) were significantly associated with higher serum levels of total testosterone (TT, p = 0.0086). In conclusion, PAI1 polymorphism seems to be associated with the risk of PCOS development. Younger PCOS women had specific genotypes of INSR, IGF2 and PAI1 genes. AR shorter alleles can be associated with higher serum levels of TT in PCOS patients.

Relationship between Serum Lipoprotein Ratios and Insulin Resistance in Polycystic Ovary Syndrome

Objective. To investigate the association between serum lipoprotein ratios and insulin resistance in women with polycystic ovarian syndrome (PCOS). Methods. 105 PCOS patients and 109 controls were randomly enrolled in the study. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), total testosterone (T), fasting glucose (FBG), fasting insulin (FINS), serum triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) levels were checked, and then TG/HDL-C ratio, TC/HDL-C, ratio and LDL-C/HDL-C ratio were calculated. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to calculate the insulin resistance. Results. All lipoprotein ratios were significantly higher in PCOS patients as compared to healthy controls (P < 0.05). TG/HDL-C ratio, TC/HDL-C ratio, and LDL-C/HDL-C ratio were significantly correlated with HOMA-IR (P < 0.05). The ROC curve demonstrated that TC/HDL-C ratio had higher sensitivity and specificity in diagnosing PCOS with insulin resistance. Conclusion. This study demonstrates that serum lipoprotein ratio significantly correlates with insulin resistance and can be used as the marker of insulin resistance in PCOS patients.

Anxiety is associated with hormonal and metabolic profile in women with polycystic ovarian syndrome

BACKGROUND

Increased prevalence of psychological morbidities, including anxiety, depression and eating disorders, has been reported in women with polycystic ovary syndrome (PCOS) in comparison with normal ovulating, nonhyperandrogenemic women.

AIM OF THE STUDY

To investigate the relationship between the degree of anxiety, depression and eating disorders via self-reported symptoms and the severity of hormonal and metabolic aberrations in women with PCOS. For this purpose, the PCOS cohort was subdivided into three subgroups according to the degree of anxiety.

METHODS

One hundred and thirty women with PCOS of similar age and BMI were studied. In each subject, hormonal and metabolic status as well as psychological profile was assessed with the use of specific questionnaires. Specifically, anxiety (trait and state) was assessed with the use of STAI-T and STAI-S, while depression and eating disorders were evaluated with the use of the Beck Depression Inventory and the Eating Attitudes test, respectively.

RESULTS

The subgroups did not differ in age and BMI. Subjects with the highest STAI-S compared with those with the lowest STAI-S displayed significantly higher the homeostasis assessment model-insulin resistance (HOMA-IR) and free androgen index values (P < 0·05), respectively. Regarding trait anxiety, assessed by STAI-T, HOMA-IR values were significantly elevated (P < 0·05) in the subgroup with the higher STAI-T score compared with the HOMA-IR in the group with the lower STAI-T score.

CONCLUSIONS

In women with PCOS, the degree of anxiety, state and trait (STAI-S, STAI-T) appears to vary in a pattern similar to that of hyperandrogenemia and insulin resistance, independently of age and BMI. The pathophysiological mechanisms underlying the association of psychological morbidities with androgen excess and insulin resistance in PCOS remain to be elucidated.

Testosterone and mood dysfunction in women with polycystic ovarian syndrome compared to subfertile controls

Women with polycystic ovarian syndrome (PCOS) have been found to suffer from fertility problems and mood dysfunction. To control for any effect of fertility problems, the present study compared mood dysfunction in women with PCOS to non-PCOS women with fertility problems. Seventy-six women with PCOS and 49 subfertile controls reported their anxiety, depression and aggression levels, and the relationship between mood and testosterone (T) was assessed. Controlling for age and BMI using MANCOVA, women with PCOS were significantly more neurotic (had difficulty coping with stress) than controls, had more anger symptoms, were significantly more likely to withhold feelings of anger and had more quality of life problems related to the symptoms of their condition (acne, hirsutism, menstrual problems and emotions). In a subgroup of 30 women matched on age, BMI and ethnicity, it was found that women with PCOS were significantly more anxious and depressed than controls. T was not generally correlated with mood states. This is the first study to identify problems with neuroticism and withholding anger in women with PCOS. These mood problems appear to be mainly attributable to PCOS symptoms, though other factors, such as hypoglycaemia, cannot be ruled out.